Distilling the essence of breathlessness: the first vital symptom.

Our patients don’t expect miracles, but they do expect support, real support. Rightly, they expect a clinician who is prepared to ask them how they are functioning on a day-to-day basis, what it is like to be this breathless and what would most make a difference. Most importantly, most of our patients are already too wise to expect that we can actually fix the breathlessness of advanced chronic obstructive pulmonary disease or interstitial lung disease, but there are things that we can do to support them without feeling the pressure to pretend we can make everything right. The very act of acknowledging the presence and impact of breathlessness is, in itself, a therapeutic intervention. It validates the experience of the person with breathlessness and gives explicit permission to talk about the effect on his/her life. The benefits of genuine empathy in the clinical encounter should not be underestimated.